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Adjuvant Intraarterial Injection of ¹³¹I-Labeled Lipiodol After Resection of Hepatocellular Carcinoma: Progress Report of a Case-Control Study with a 5-Year Minimal Follow-up

¹ Département d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France; ² Département d'Imagerie Médicale, Centre Eugène Marquis, Rennes, France; ³ Service Des Maladies du Foie, CHRU Pontchaillou, Rennes, France; and ⁴ Département de Chirurgie Viscérale et de Transplantation Hépatique, CHRU Pontchaillou, Rennes, France

Correspondence: For correspondence contact: Eveline Boucher, MD, Centre Eugène Marquis, CS 44229–35062 Rennes Cedex, France. E-mail: boucher{at}rennes.fnclcc.fr

Recurrences after resection of hepatocellular carcinoma are frequent. A single postoperative injection of ¹³¹I-labeled lipiodol in the hepatic artery was shown in 1999 by Lau and colleagues to be an effective adjuvant treatment, and those results were strengthened by our experience with a case-control study, reported in 2003. The goal of this paper is to update the 2003 results for a minimal follow-up of 5 y. Methods: Between January 1999 and September 2001, 38 patients were given an adjuvant postoperative intraarterial injection of ¹³¹I-lipiodol and were matched (for Okuda group and tumor size) with 38 patients who had undergone resection between January 1997 and January 1999 without postoperative treatment. The 2 groups were similar. Results: There were 28 recurrences in the control group and 22 in the ¹³¹I-lipiodol group (not statistically significant), and the mean time of recurrence was 21 and 26.5 mo, respectively, after surgery (statistically significant). The number of recurrences was lower in the first 2 y in the ¹³¹I-lipiodol group (statistically significant). Disease-free survival was better (P < 0.03) in the ¹³¹I-lipiodol group than in the control group (2-, 3-, and 5-y rates [±95% confidence interval] of 77% ± 7%, 63% ± 8%, and 42% ± 8.5%, respectively, for the ¹³¹I-lipiodol group vs. 47% ± 8%, 34% ± 8%, and 27% ± 8%, respectively, for the control group). Overall survival did not differ between the 2 groups (P = 0.09), even though there was a trend toward better survival in the ¹³¹I-lipiodol group (2-, 3-, and 5-y rates of 76% ± 7%, 68% ± 7.5%, and 51% ± 9%, respectively, vs. 68% ± 7.5%, 53% ± 8%, and 39% ± 8%, respectively, in the control group). Conclusion: With a longer follow-up, the results of this retrospective case-control study still favor a single postoperative injection of ¹³¹I-lipiodol. These retrospective findings point out the need for a large-scale, prospective, randomized study.

Key Words: primary liver cancer • surgery • adjuvant treatment • internal radiotherapy • ¹³¹I-labeled lipiodol

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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